Medical Education 2012: 46: 49–57

Context  In response to historical trends in expectations of doctors, the goals of medical education are increasingly framed in terms of global competencies. The language of these competencies has tended to adopt a prescriptive, rather than descriptive, approach. However, despite widespread agreement on the importance of competency-based education and more than two decades of study, this effort has not generated a dependable set of assessment tools.

Discussion  Because models of competency are legislated, rather than shaped by scholarly consideration of empirical data, it is unlikely that such models directly reflect actual human behaviour. Efforts to measure clinical behaviours could benefit from increased clarity in three related conceptual areas. Firstly, the language of educational constructs should be framed in terms of data-based hypotheses, rather than in terms of intuitively plausible abilities. Secondly, these constructs should be specified in terms of the situations to which they are relevant, rather than as global personal characteristics. Finally, the resources required to measure these constructs should be rigorously established because a common resource-based metric would allow for rational selection of assessment methods. Specific methods to establish each of these objectives are discussed.

Conclusions  The political process of negotiating educational objectives should not be confused with the scientific work of establishing coherent and interpretable patterns of behaviour. Although the two activities can complement one another, each has its own distinct methods and style of discourse. It is thus critical to maintain boundaries between these two approaches to defining professional performance.